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INTERSTITIAL CYSTITIS(PAINFUL BLADDER SYNDROME)

GENERAL

Clinical Manifestations	Interstitial cystitis (IC), also known as bladder pain syndrome (BPS), is a type of chronic pain that affects the bladder. Symptoms include feeling the need to urinate right away, needing to urinate often, and pain with sex and worsening of pain during menstruation. IC/BPS is associated with depression and lower quality of life. Many of those affected also have irritable bowel syndrome and fibromyalgia. Other conditions which can produce similar symptoms include urinary tract infection (UTI), overactive bladder, sexually transmitted infections, endometriosis, bladder cancer, and prostatitis. Interstitial Cystitis is divided into two types: 1. Non-uilcerative: Primarily affects young and middle aged women. 2. Ulcerative: Primarily affects middle-aged and older women.
Treatment Principle
Herb Formulas
Points

SPLEEN QI DEFICIENCY

Clinical Manifestations	Frequent, long, clear urination Maybe urinary incontinence or enuresis Pale or sallow complexion Pale lips Fatigue Lassitude Weakness Dizziness Anorexia Four limbs feel cold, tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath Maybe facial edema T: Pale and flabby - may have teethmarks C: White P: Even, forceless and deficient
Treatment Principle	Strengthen the Spleen Benefit Qi
Herb Formulas	Bu Zhong Yi Qi Tang modified
Points	DU-20, REN-4, REN-6, SP-6, ST-36 For frequent urination: + REN-3 For susceptibility to the common cold: + DU-14, LI-4 For Phlegm-Damp obstructing the Lungs: + UB-12, UB-13 For Food Stagnation: + ST-21 With Kidney Qi Deficiency: + KI-3 With Heart and Spleen Deficiency: + HT-7 LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

SPLEEN QI AND HEART BLOOD DEFICIENCY

Clinical Manifestations	Frequent, long, clear urination Maybe urinary incontinence or enuresis Palpitations Insomnia Much dreaming Easily startled Poor memory Four limbs tired and lethargic Loss of appetite Distention and fullness of the epigastrium and abdomen Loose stools Sallow complexion Copious, pale menses Uterine bleeding or Light menstrual flow or Amenorrhea T: Pale P: Thready and weak
Treatment Principle	Reinforce and Benefit the Heart and Spleen modified
Herb Formulas	Gui Pi Tang modified
Points	DU-20, REN-4, REN-6, SP-6, ST-36 For frequent urination: + REN-3 For susceptibility to the common cold: + DU-14, LI-4 For Phlegm-Damp obstructing the Lungs: + UB-12, UB-13 For Food Stagnation: + ST-21 With Kidney Qi Deficiency: + KI-3 With Heart and Spleen Deficiency: + HT-7 HT-7, REN-4, SP-1, SP-6, ST-36, UB-15, UB-20

STOMACH EXCESS WITH SPLEEN DEFICIENCY

Clinical Manifestations	Frequent, possibly dark urination A tendency toward dry, hard stools Rapid hungering A large appetite Maybe abdominal fullness Maybe fatigue T: Fat and enlarged C: Yellow, maybe dry P: Slippery and wiry and maybe floating
Treatment Principle	Clear the Stomach Moisten the Intestines Strengthen the Spleen Tonify Qi Circulate Qi Unblock the stools
Herb Formulas	Xiao Chai Hu Tang + Ma Zi Ren Wan modified
Points	KI-6, SJ-6, SP-6, ST-44, UB-21 With dysuria and constipation: + UB-54 With Liver Qi Stagnation: + LIV-4, LIV-8 With abdominal pain: + SP-15 With bad breath: + ST-41 With Heart vexation: + HT-7 With severe constipation: + ST-37 Without dry stools: - KI-6 With marked Spleen Deficiency and Dampness: + SP-3, SP-9 With severely painful or burning urination: + KI-5 With lower abdominal distention and pain: + LIV-9 With rib pain: + LIV-14 With a bitter taste in the mouth due to Damp-Heat: + GB-43

LIVER QI STAGNATION WITH DAMPNESS ACCUMULATION

Clinical Manifestations	Frequent urination An unfinished feeling after voiding Rib discomfort Lower abdominal distention and fullness Irritability Possible pre-menstrual or menstrual breast distention and pain T: normal or Dark and possibly swollen C: Greasy and white P: Wiry
Treatment Principle	Dredge the Liver Regulate Qi Eliminate Dampness Promote urination
Herb Formulas	Chai Hu Shu Gan Tang modified
Points	LIV-2, LIV-4, LIV-8, REN-2, UB-54 With Blood Stasis: + SP-6, SP-10 With stagnant Heat in the Liver and Stomach: + ST-44 With painful menstruation: + ST-29 With chest oppression: + PC-6 With frequent belching: + REN-15 With severe Liver Stagnation: + PC-5 With Spleen Deficiency: + ST-36 With severely painful or burning urination: + KI-5 With lower abdominal distention and pain: + LIV-9 With frequent sighing: + GB-34 With rib or flank pain: + LIV-14 With bitter taste in the mouth due to stagnant Heat: + GB-43

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Urinary frequency with abundant, clear urine or Oliguria with edema Maybe urinary incontinence or enuresis Lumbago: low back feels cold, weak and aching Feeling chilled Aversion to Cold Cold limbs General debility Pale or bright white face Maybe nocturia Lassitude Withdrawn, subdued behavior Knees feel cold and aching Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen C: Thin and white P: Deep and thready - maybe slow
Treatment Principle	Warm and Reinforce Kidney Yang
Herb Formulas	You Gui Wan modified
Points	Moxa or moxa needle KI-3, REN-4, UB-23, UB-52 For panting: + KI-2 For dribbling urination: + UB-28 For frequent nocturia: + KI-6 For clear, thin vaginal discharge: + GB-26 Moxa or moxa needle DU-4, KI-3, REN-4, UB-23 For chronic diarrhea, rectal prolapse and Vanquished Yang: + moxa DU-20, REN-8 For Kidney Yang Deficiency impotence: moxa or moxa needle DU-4, DU-20, KI-3, REN-4, UB-23 For Kidney Yang Deficiency (Cock Crow) Diarrhea: moxa or moxa needle DU-20, KI-3, REN-4, UB-23

KIDNEY YIN DEFICIENCY WITH EMPTY FIRE FLARING

Clinical Manifestations	Frequent short, red urination or Scanty, concentrated urine with difficulty initiating the flow Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of the low back Spermatorrhea or Premature ejaculation Aching in the bones Aching in the leg and heel Dry mouth and throat Thirst Night sweats Five Sole Heat Malar flush Low grade fever in the afternoon Dry throat, maybe recurrent sore throat Dry stools and/or Constipation Heightened libido If Heart Fire also Flares: Insomnia Vexation Frequent dreams Palpitations If Liver Yang also Rises: Dizziness Blurred vision T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Subdue Fire
Herb Formulas	Zhi Bai Di Huang Wan modified Liu Wei Di Huang Wan + Zhu Ling Tang For damaged Yin from enduring Damp-Heat: E Jiao San Jia Jian Chinese Patent Medicines: Liu Wei Di Huang Wan Zhi Bai Di Huang Wan Da Bu Yin Wan
Points	KI-2, KI-6, KI-7, REN-4, SP-6 With Heart palpitations: + UB-15 With just insomnia: + HT-7 With Five Sole Heat and night sweats: + HT-6 With seminal emission: + UB-52 With scanty urination or blocked menstruation: + SP-10, ST-29 For severe Kidney Yin Deficiency with Fire Rising: + KI-8, KI-10 With hematuria: + SP-10 KI-1, KI-2, KI-3, KI-6, KI-9, KI-10, REN-4, SP-6, UB-23 If Heart Fire also Flares: + HT-7, PC-7, UB-15 If Liver Yang also Rises:+ LIV-3, UB-18 HT-5, KI-3, KI-6, LU-7, REN-3, REN-4, REN-6, SP-6, UB-23

KIDNEY QI DEFICIENCY

Clinical Manifestations	Frequent urination Copious amounts of clear urine Incontinence of urine Enuresis Dizziness Restlessness Either a tendency towards being too hot of too cold Shortness of breath Asthma Cold limbs Weak back and knees Diarrhea or Constipation Amenorrhea Abortion or miscarriage Thirst T: Pale C: White P: Deep, weak possibly tight
Treatment Principle	Tonify Kidney Yang Nourish Kidney Yin Clear Heat
Herb Formulas	Interstitial Cystitis #2
Points	Group 1 (patient lying face up): KI-3, KI-11, KI-12, REN-4, REN-6, SP-6, ST-28 With Damp-Heat: + KI-8, SP-9 DU-4, UB-22, UB-23, UB-24, UB-29, UB-35, UB-39

QI AND BLOOD DEFICIENCY

Clinical Manifestations	Frequent, long, clear urination Maybe urinary incontinence or enuresis Fatigue Loose stools Poor appetite Dizziness Pale face Weak voice Reluctance to speak Sweating with little or no exertion Palpitations Insomnia Dry skin Dry hair Poor memory Paleness Scanty periods T: Pale or Pale, thin and dry C: Thin and white P: Weak or Thin and choppy
Treatment Principle	Tonify Qi Nourish the Blood
Herb Formulas	Ba Zhen Tang modified
Points	DU-20, REN-4, REN-6, SP-6, ST-36 For frequent urination: + REN-3 For susceptibility to the common cold: + DU-14, LI-4 For Phlegm-Damp obstructing the Lungs: + UB-12, UB-13 For Food Stagnation: + ST-21 With Kidney Qi Deficiency: + KI-3 With Heart and Spleen Deficiency: + HT-7 KI-3, LIV-3, LU-9, SP-6, ST-36, UB-11, UB-17

BLOOD STAGNATION

Clinical Manifestations	Frequent, painful , dark urination Turbid urine Maybe purple clots in the urine Dribbling urination Lower abdominal distention and pain Pain is worse with pressure T: Dark with purple macules or spots C: White P: Choppy and/or wiry
Treatment Principle	Invigorate the Blood Break up Stasis Free the flow of urine
Herb Formulas	Shao Fu Zhu Yu Tang modified
Points	KI-5, REN-3, SP-6, UB-54 With urethral distention and pain: + LIV-4 With lower abdominal or umbilical area distention and pain: + REN-6 With stone strangury: + KI-2, UB-39

DAMP-HEAT IN THE LOWER JIAO

Clinical Manifestations	Frequent, urgent, painful urination A burning, hot sensation in the urethra A sticky, dry mouth Thirst with no desire to drink Lower abdominal distention and fullness Constipation T: Red C: Yellow P: Slippery and rapid
Treatment Principle	Clear Heat Eliminate Dampness
Herb Formulas	Ba Zheng San With Blood stagnation: Interstitial Cystitis #1
Points	LIV-8, REN-3, SP-6, UB-54 For a fever, a bitter taste in the mouth, nausea and vomiting: + SJ-3, UB-22 For constipation: + KI-6, SJ-6 For a fever: + LI-11 For colicky pain in the abdomen and low back: + UB-27 For severely painful or burning urination: + KI-5 With Qi Deficiency: + SP-3, ST-36 For Liver Stagnation: + LIV-2, PC-5 With Kidney Deficiency: + KI-3 For hematuria: + SP-10 For nausea: + PC-6, or REN-13